2.2.6 Safe and unsafe injecting

Page last updated: June 2008

Those consulted in various locations typically believed that many Indigenous IDUs were currently fairly well informed about issues relating to safe injecting and the risks of sharing equipment. The most likely exceptions to this generalisation, it was thought, were young, inexperienced injectors.

IDUs consulted in Alice Springs, for example, believed that knowledge about the importance of safe injecting was widespread ('A lot of people think about things like that now'; 'Everybody's on the ball now, hygiene and that'). Some specifically related this change to the increased availability of NSP services and sterile equipment. An AMS health worker in Sydney commented that when she speaks with IDUs about safe injecting, 'They all say they know about it'. Clients may often say that they would never share a needle – except 'with my partner', or 'if I was off my face'. In Taree, Carnarvon and Canberra there were references to people known to be uninfected 'going first' with a shared fit. In Darwin both Indigenous and non-Indigenous IDUs were thought to be generally quite well informed about safe injecting – though of course this did not mean that injecting was always safe.

Having the relevant 'head knowledge' was no guarantee of consistently safe injecting behaviour, among either Indigenous or non-Indigenous IDUs. It was often said that if you were 'hanging out' and a clean needle was not readily available, you might well share (possibly making some attempt to clean the equipment, such as rinsing a couple of times with water). 'At the time they don't care', said a health worker consulted in Canberra. 'Come crunch time, when they're hanging out'. 'It doesn't matter – all they want is that hit' (worker, Taree). 'The understanding is there, but – '(Carnarvon); 'There's a helluva lot of risk behaviour' (Perth).

Nights and weekends were obvious times when obtaining sterile equipment could be difficult. 'Sunday's the hard day', said a drug user in Canberra; you have to try to 'keep a stash' for the weekend. There was reference to reuse of one's own needles – possibly many times – perhaps giving the syringe a 'quick little rinse' with water or mouthwash before re-use.

The fact that a group of friends or acquaintances might pool funds in order to purchase drugs – reportedly a common practice among Indigenous IDUs – tended to give a communal or collective flavour to the drug using, which could be conducive to sharing of injecting equipment. In western Sydney, for example, it was said that some Indigenous IDUs routinely share needles. A drug and alcohol worker consulted in Mildura stated that in the past she had had Indigenous IDU clients who had shared and re-used needles and had made little if any use of the local NSP; her view was that there was a good deal of unsafe injecting by Aboriginal people. Failure to use NSP services was attributed partly to apathy and partly to a fear of being identified as an injector. A Dubbo IDU said that he was associated with a group of about 30 drug users – both Indigenous and non-Indigenous – among whom a minority would share equipment.

In one location it was said that the situation where a dealer offers a drug free (eg to potential new customers – 'first shot free' and a 'bonus' for the person introducing the new client) could encourage sharing of a needle. In Canberra it was suggested that NSPs distributing one-shot containers of sterile water were far preferable to issuing 'one big water', which could encourage sharing behaviour.Top of page
While some of the IDUs who took part in the study said that they would never share a needle, other people believed that sharing was relatively common – especially by couples or among close friends or family members. In Canberra, for example, a group of IDUs who knew each other well took part in a round-table discussion; they indicated that they had certainly shared needles with each other (rinsing with water between users, or with bleach if it happened to be available). 'Everybody shares' with their mates or their family, it was said.

In Alice Springs the point was made that there was 'a very strong sharing culture' in Aboriginal communities. It was agreed that this had relevance for injecting drug use, with pressure on individuals to share both their drugs and their needles ('Share the gear and share the equipment'). Some IDUs (eg in Taree) commented that the larger the group you injected with, the more pressure there could be to share your drugs. Elsewhere IDUs said that 'Everything belongs to everyone'; 'There's no such thing as 'mine' – 'Come on, bro'. Thus, while it is no doubt simplistic to say that Indigenous IDUs share injecting equipment because they come from a culture where sharing is the norm, this research suggests that a combination of factors such as using drugs with groups of relatives and friends, pooling funds to buy drugs, and peer pressure against 'selfish' or individualistic behaviour, do tend to increase the possibility of unsafe injecting.

A Cairns IDU spoke about his injecting practice with his partner. Both of them had hepatitis C, he said, but 'different strains'. He said that he normally shared a needle and syringe with the partner: 'I do her first, then wash it out' – first with cold water, then boiling water. A Cairns worker thought that people sometimes took the view that sharing a needle added no extra risk on top of unprotected sex.

It was clear that there remained gaps in knowledge. In Cairns, for instance, a male IDU said that originally he had been very ignorant about hepatitis C; he had thought it was 'something that you get overseas' – 'a bad flu sort of thing'. QuIHN in Cairns, said another IDU, 'still sees people who've got no idea', while a Cairns NSP worker said that if she asked a few questions of clients she often found ignorance or confusion about hepatitis C infection. For instance it was still easy for people to be confused between hepatitis A, B and C.

Sharing of equipment can also arise through confusion or mistake. When people are injecting together and re-using their needles, said a Cairns IDU, 'after a while you don't know whose was whose'. 'Their minds are so scattered' (Canberra worker). Another IDU interviewed in Cairns said that some people are 'too far gone to care' whether or not they are injecting safely – or else 'just lazy'. Users may also assume that 'you haven't got anything I haven't got'. The bottom line for some IDUs was that lack of a clean needle 'wouldn't stop them shooting up'; 'It there's one needle and five of us want a shot', it was highly likely that the needle would be shared – with or without an effort to clean it between users.

In Canberra injecting was reported as often unsafe in various ways. It was said that people may use in the open (eg in a park or laneway) or in public toilets, in very unhygienic circumstances. Further, 'I've seen people so desperate they'll pick up a needle from the street' (Canberra IDU). IDUs thus needed to be taught as fully as possible about clean practices in all situations. A Darwin IDU commented that, while there was not a big local 'street scene' injecting did take place in locations – eg at the beach or in public toilets – where hygienic practice was difficult. Workers in Cairns likewise referred to young Aboriginal IDUs injecting in parks or in the street.